Giant pelvic abscess with sepsis: Case report and review of current literature

INTRODUCTION: Intra-abdominal and pelvic abscesses can develop because of multiple etiologies. Typically, these abscesses are managed via a combination of medical (antibiotics) and surgical (drainage) interventions. This is a unique case report of a giant idiopathic pelvic abscess with necrotizing fasciitis that failed conservative management with antibiotics, requiring urgent surgical intervention and complex closure of the wound. CASE PRESENTATION: A 71-year-old female presented to the emergency department in sepsis, complaining of right hip and flank pain of one-month duration. Imaging revealed a giant right flank abscess with necrotizing fasciitis. The abscess extended from the pelvis to the right retroperitoneal space, traversing several soft tissue planes, to the skin. She was treated emergently with open surgical drainage, debridement, and delayed complex closure. The patient significantly improved post-operatively and was subsequently discharged. DISCUSSION: Pelvic abscesses are commonly due to gastrointestinal, genitourinary, post-surgical, or rarely idiopathic causes. US, CT, or MRI are the imaging modalities effective in diagnosing and staging abscess severity. Currently percutaneous, image-guided abscess drainage is the primary management due to it being minimally invasive, having better outcomes and reduced hospital stay. In large, multi-loculated abscess as exhibited by our patient, open surgical drainage and debridement of the infected cavity was not only successful but imperative in effective resolution. CONCLUSION: Most pelvic abscesses can be treated with percutaneous drainage but those complicated by necrotizing fasciitis, or multi-loculated collections may be better treated with open drainage.